What happens after you get into a car accident, and who pays the bills, could be changing.

State lawmakers are wrestling with ways to reform the state’s no-fault auto insurance law. The law requires drivers carry $10,000 worth of coverage and forces insurance companies to pay out regardless of who caused the accident.

The system is rife with abuse, lawmakers say — an estimated $1 billion in fraud this year.

But there is no simple fix, and several competing proposals are being floated by Republicans in Tallahassee.

One tightens procedures for licensing medical clinics and creates a task force to help stamp out abuse. Another requires car accident victims to seek initial treatment at emergency rooms and limits the type of medical services that are covered. A third measure repeals the law entirely and replaces it with a system where the person who caused the crash pays.

“I’m optimistic that we’ll be able to address the issue before we’re through here,” said Sen. Joe Negron, a Palm City Republican.

He just doesn’t know how yet.

Gov. Rick Scott urged action in his State of the State address Tuesday, calling on legislators to pass substantive fixes to the system, called Personal Injury Protection insurance, or PIP. In recent years, similar efforts have been watered down by politics.

Scott backs a House proposal that keeps the requirement of $10,000 in mandatory coverage but makes hospitals the first stop for treatment instead of a family doctor. The House proposal also limits which medical professionals provide follow-up care.

“You know there’s other approaches to license providers and all sorts of things,” Scott told The Associated Press, “[but] I think that bill is a good bill and I’m very supportive of it.”

That measure, introduced by Rep. Jim Boyd, R-Bradenton, passed a subcommittee this week and has the support of the state Office of Insurance Regulation and the Property Casualty Insurers Association of America.

The bill is unpopular with Democrats, however, who say it goes too far and limits personal choice. It’s also opposed by trial lawyers who don’t like a provision to cap attorney fees and by physicians who believe some of the provisions are too heavy-handed.

The opponents generally prefer another idea, sponsored by Negron and state Rep. Ritch Workman, R-Melbourne, that tightens regulations for medical clinics, requires more detailed accident reports and creates a statewide anti-fraud task force.

“Ultimately, the single biggest thing we can do to control fraud is to require a ticket to participate in PIP that is regulated heavily by the state,” said attorney Russel Lazega, who represents hospitals and other medical providers.

Neither Negron nor Workman’s legislation limits attorney fees. (Negron is a lawyer; Workman is a mortgage broker.)

A cap is an “essential element” that should be contained in any PIP reform package to lower costs, said Donovan Brown of the Property Casualty Insurers.

That organization, along with business groups and lawyers, has also expressed support for PIP repeal efforts, but the idea remains unpopular among medical providers and consumer advocacy groups.

The Florida Hospital Association isn’t supporting any specific bill but said eliminating the no-fault insurance system would ultimately affect quality of care. More than a third of emergency room patients have no other health coverage beyond PIP, general counsel Bill Bell said.

Rep. Mike Horner, R-Kissimmee, and Rep. Mack Bernard, D-West Palm Beach, introduced legislation to repeal PIP. They want drivers to carry bodily injury insurance that goes into effect when they hurt someone else in an accident. Forty-eight other states have a similar requirement.

Bill Newton, executive director of the Florida Consumer Action Network, said he doesn’t expect the Legislature to go that far.

“It’s an election year, so crazy stuff like that is probably not going to happen,” he said.

Among all the ideas, one proposal is already being left behind. Sen. Mike Bennett, R-Bradenton, has decided to let the legislation he filed in September die without being heard in any committees and instead will support one of the other proposals on the table, his aide said.

He hasn’t decided which one.

© 2012 Miami Herald Media Company. All Rights Reserved.